Sleeplessness and night-time wandering

Changes in behaviour

Introduction

My mother has difficulty sleeping at night. She used to wander around the house, sometimes getting lost between the bedroom and the bathroom and once she even went out. I was really worried and didn’t know what to do. Then a friend suggested fitting a safety gate at the top of our stairs, which I did. Now, I still worry but at least I know where she is.

Sometimes people with dementia are unable to sleep at night. The correct term for this is “insomnia”. Apart from becoming extremely bored, they are likely to waken others who need to sleep. But whereas they may be able to recuperate sleep at some stage the next day, others who have to work or study during the day are unlikely to be able to do so. Consequently, there is a risk that the health and general wellbeing of the whole family might suffer and this in turn could affect the quality of care you can provide.

Coping with sleeplessness and night-time wandering means finding a way to ensure that you and your family get a good night’s sleep and trying to increase the chances of the person with dementia sleeping. However, as this will not always be possible, you will also need to find ways to minimise potential risks and increase the person’s comfort during the many hours they may spend awake and alone.

How to cope with sleeplessness and night-time wandering

Try to create a safe environment

The chapter on safety will provide you with useful information on how to make your home safe for someone with dementia. However, if the person with dementia wanders at night, it would be a good idea to take a few extra precautions.

A safety gate and preventing access to the kitchen

If the person’s bedroom is located up a flight of stairs, it is advisable to have a safety gate fitted. This will discourage the person with dementia from going downstairs alone in the middle of the night. Also, you will be more likely to hear them moving about and perhaps calling for help if they do not move too far away from where you are sleeping. If you cannot install a safety gate (or if the kitchen is on the same floor as the person’s bedroom), it would be a good idea to lock the kitchen door at night. The kitchen is an extremely dangerous place for the person with dementia, particularly when unsupervised.

Locks, lights and monitors

Make sure that all doors leading out of the building are locked. Fitting locks on the outside of doors can enable you to limit access to certain rooms. You could, for example, lock all the doors except the toilet and the lounge and leave a light on in these rooms, as well as in the area leading from the person’s bedroom. But, if these rooms are on a different floor than the person’s bedroom this might not be a good idea, as they may risk falling downstairs.

Monitors

Various monitors exist which can enable you to know when the person is out of bed or has left the room. Such devices prevent you from staying awake unnecessarily and do not interfere with the person’s privacy. They are generally inexpensive and easy to install. Most detect movement using pressure, magnetism or a beam of light. Others amplify sound.

How to prevent sleeplessness and night-time wandering

Limit daytime sleeping and keep the person with dementia active

Daytime napping tends to reduce the likelihood of sleeping at night. People with dementia may sleep more during the day because they are bored, inactive or didn&rsquo;t sleep at night. A good way to help is therefore to keep the person active and stop them from sleeping during the day. This would be easier if you had access to a day centre where staff can keep the person busy all day. Physical activity and fresh air are another means to help induce sleep at night. The chapter on recreation, activities and exercise might give you a few ideas, such as walking, dancing and simple exercises.

Possible causes of sleeplessness and night-time wandering

Tranquillisers: If the person with dementia is taking tranquillisers, they might be contributing to wandering. This is because if the dose is too low, the person may wander around in a drugged state, neither fully awake nor fully asleep. Too high a dose can lead to drowsiness and increased daytime confusion, and even the right dose can increase the likelihood of night-time incontinence. Of course, if you desperately need sleep, you may well feel obliged to ask your doctor about the possibility of prescribing tranquillisers.

Disturbance of the night and day rhythm: Many people with dementia lose the ability to distinguish between night and day. It can help if you make sure that the room is dark at night, e.g. put up heavy dark curtains. Removing daytime clothing from sight may also discourage the person with dementia from getting up in the middle of the night.

Discomfort: The person will be more likely to sleep well if they are comfortable. So try to make sure that they are neither too hot nor too cold, that the bed is well made, the mattress comfortable and the window as they like it, either open or closed.

Contact a doctor if you suspect that the person with dementia is depressed

Often when a person is depressed, their sleep is disrupted. If you suspect that the person with dementia is suffering from depression (please see chapter on feeling depressed/having depression) you should consult a doctor, as he or she may be able to help.

Try offering the person with dementia a small milky or alcoholic drink

A small alcoholic or milky drink may help the person with dementia get to sleep and should not lead to incontinence. But avoid drinks containing caffeine such as hot chocolate, coffee and tea.